Leung G M, Lam T H, Thach T Q, Wan S, Ho L M
Department of Community Medicine, The University of Hong Kong, Patrick Manson Building, 7 Sassoon Road, Pokfulam, Hong Kong, China.
Birth. 2001 Sep;28(3):166-72. doi: 10.1046/j.1523-536x.2001.00166.x.
High cesarean birth rates are an issue of international public health concern. The purpose of this paper was to examine the annual incidence and secular trend of cesarean births in Hong Kong and to correlate these rates with socioeconomic, demographic, and health indicators for the population since 1987.
This was a descriptive and ecologic study. Annual population rates of cesarean sections were estimated for 1987 from a population-based survey, and for 1993 through 1999 from government data sources. The number of excess cesarean sections was calculated for each year using the 15 percent upper limit as proposed by the World Health Organization.
From 1987 to 1999 the overall annual cesarean section rate rose steadily from 16.6 to 27.4 per 100 hospital deliveries, resulting in a 65 percent increase over 12 years. The mean difference in rates of surgical delivery between public (mean(public) = 16.0%) and private (mean(private) = 43.4%) institutions was 27.4 percent (95% confidence interval (CI) = 24.1, 30.7; p < 0.001).
This is the first systematic report of secular variations of cesarean delivery rates in Asia. The high rates and increasing trend represent an unnecessary excess risk for mothers and their infants. Various strategies combating high cesarean rates have been proposed and have succeeded elsewhere. Concerted action from health care professionals, public health authorities, the general population, and the media is urgently required to implement solutions to reduce the rate of cesarean delivery.
高剖宫产率是一个国际公共卫生关注的问题。本文旨在研究香港剖宫产的年发病率和长期趋势，并将这些比率与自1987年以来该人群的社会经济、人口统计学和健康指标相关联。
这是一项描述性和生态学研究。1987年的剖宫产年人口率通过一项基于人群的调查估算得出，1993年至1999年的数据则来自政府数据源。每年使用世界卫生组织提议的15%上限计算剖宫产的超额数量。
从1987年到1999年，剖宫产的总体年率稳步上升，从每100例医院分娩中的16.6例升至27.4例，12年间增长了65%。公立机构（平均（公立）=16.0%）和私立机构（平均（私立）=43.4%）手术分娩率的平均差异为27.4%（95%置信区间（CI）=24.1，30.7；p<0.001）。
这是亚洲首次关于剖宫产率长期变化的系统报告。高比率和上升趋势对母亲及其婴儿构成了不必要的额外风险。已经提出了各种应对高剖宫产率的策略，并且在其他地方取得了成功。迫切需要医疗保健专业人员、公共卫生当局、普通民众和媒体采取一致行动来实施降低剖宫产率的解决方案。
